PASS - A SCORING SYSTEM TO EVALUATE PERSISTENT ACUTE KIDNEY INJURY IN CRITICALLY ILL ADULT ICU PATIENTS

Acute Kidney Injury (AKI) and sepsis is highly prevalent in Intensive Care Units (ICU) and has direct effect on mortality and morbidity. We aimed to evaluate if course and recovery of  sepsis-AKI can be predicted using variables collected at the time of admission, and to develop a formula - Persistent AKI Scoring System (PASS) to predict recovery.

63 consecutive patients admitted for sepsis-AKI in our ICUs were evaluated over a period of 8 months. Baseline demographic and clinical/laboratory parameters ,including serum creatinine (SCr), Base Excess (BE), Plethysmographic Variability Index (PVI), Caval Index, R wave Variability (RVI), Mean Arterial Pressure (MAP) and Renal Resistivity Index (RI) using renal doppler and need for inotropes were assessed on admission. Patients were managed with standard protocols with fluid resuscitation and other specific therapy. After 6 of hours of fluid resuscitation, hemodynamic status and volume status of the patient was assessed. Patients were classified as Volume Responders or Non-responders depending on hemodynamic stabilization using parameters like MAP. Re- assessment of all the variables was done at 24 hours and 72 hours after admission. The primary outcome was persistent AKI after 72hrs. The secondary outcome was initiation of dialysis and death within 15 days of admission.

34 subjects recovered from AKI.  32 patients showed volume response with respect to hemodynamic parameters and 31 patients were non-responders. Response to fluid, MAP at admission, MAP after 6 hours, BE at admission, inotrope requirement, and PVI at admission did not correlate with recovery of AKI. RI, RVI and S Cr at admission significantly correlated with recovery from AKI These 3 parameters were evaluated further to develop the model for predicting recovery from AKI.• Score> 7.8 predicted recovery from AKI with sensitivity of 79.4%, specificity of 72.4%. PPV 81.8% and NPV 76.7%. PASS Score>7.8 had AUROC of 0.85.

Multiple logistic regression showed that SCr< 2.36 mg%, RVI > 14.45 and RI < 0.8 on   admission correlated with recovery.

PASS SCORE Formula was created using the same.

CONCLUSION: PASS score can be a simple bed side method to reliably identify salvageable cases of sepsis-AKI, guiding fluid resuscitation and also aiding early referrals from rural to higher centers for better management.